Eating to Death and Bad Arguments Against Paying for NHS Treatment; Or, Injustice Shapes Our Behaviour

Surely you must know the adverse effects of bad diet and no exercise. Why should the taxpayer pay for what is, ultimately, the exercise of your freedom of choice? This is the question that Jeremy Paxman asked the former NHS chief Sir David Nicholson, when Nicholson went to Newsnight to describe his transition from being the head of the NHS to becoming yet another NHS patient with diabetes.

The question of whether we should pay for people's bad choices is based on some fundamentally flawed assumptions. We assume that people that are obese, that do drugs, or abuse alcohol, exercise their freedom of choice in a level playing field of choices and opportunities. Why would you grab a tin of lager when you can buy an orange juice?, the question goes. Why did you take drugs in the first place? Didn't you know that excessively eating unhealthy food will dramatically increase your chances of getting diabetes?

These sort of questions assume that individuals have all possible options available to them, and that their only responsibility is to make informed choices on what to consume. Choices that are totally their own, that are not influenced by social, cultural or economic reasons. This individualistic perspective misses entirely the point.

I assume that the reason for the bad diet of the NHS chief was not lack of money. This is the reason for many people though. Five years ago I decided to give up meat. Until then I used to eat frozen buttered chicken all the time. Day in, day out, I was eating buttered chicken and rice. It was the most time and cost efficient way to feed myself as an undergraduate student in Southampton. Once I decided to give up meat and consume more vegetables, I was confronted with a reality I wasn't aware of: that it is considerably more expensive to eat healthily than to just eat. Eating responsibly is even more expensive, but that's another story altogether.

You get much more food for your money's worth when considerations of healthy living are not factored in. I am fortunate enough to have the ability to include considerations of healthy eating in my life but many others aren't as lucky. To blame them for not choosing what is financially not an option for them, is hypocritical and shifts the focus away from the real issue--that we live in a society that sponsors and encourages the consumption of unhealthy food, a society where healthy eating comes at a cost that many people can't bear.

Paxman's question, although it was possibly asked in good faith, vilifies the working class; the group of people that historically have the highest rates of obesity, drug and alcohol abuse. The underlying narrative being that their inferior choices define them.

But class is not an isolated factor in making these bad choices. We live in a society where interaction beyond the workplace takes place over large glasses of alcohol. The pub is a social venue, one of the few public spaces where people talk to each other face-to-face. Combine that with a shitty job, a zero-hour contract and a constant panic of whether you will be able to pay the bills, and you can understand why the relaxation that two pints of lager give is a way out of the frenzy that is the everyday struggle for survival.

The case with drugs is similar. Most people can't send their children to tax-exempt fancy public schools, like Eton. Funding to state-schools is allocated according to the schools' performance. Enrolment to state-schools depends on geographical location, with post code being one of the decisive qualifications for enrolment. This has created a vicious circle of inequality, where underprivileged areas score low, get less funding and inferior quality of education. The kids that become adults, are immobile, confined socially and geographically. The existing structures of inequality are perpetuated and the gab between rich and poor widens, all the while the blame goes to those 'individuals' and their 'individual choices' living in those neighbourhoods. Then we all act surprised when people living in poor ghettoised areas with bad schools do drugs. We also make TV programs about them, sensationalising their marginalisation.

People should not be held responsible for what is the outcome of brute bad lack. People also have agency--they have the ability to decide between the limited choices that they have, for instance, they are able to make the choice of not to do drugs or to decide whether to drink five tins of lager every night. In order to be able to make a sensible distinction between what is the outcome of choice and what is the outcome of brute bad lack, we need to move past the narrow individualistic perspective and we need to put the individual in her social context and consider the social and economic factors that might explain the behaviours that we criticise.

We need to analyse groups more than we do individuals. Don't focus on why Russell Brand did drugs. It is not about the individual persons. It is about the groups. The question should be why people that grew up like Russell Brand do drugs? If we study the groups rather than the individuals, we allow for individual variations and we get a more accurate picture of the structures that encourage these behaviours, be them binge eating or drinking, or taking drugs. Until we can distinguish between choice and bad luck and eliminate existing inequalities, the tax-payer will rightfully pick up the tab, not as a punishment but rather as a premium for his or her good luck.